Trials and tribulations of evidence-based medicine: The case of alzheimer disease therapeutics

Abstract

The practice of EBM has evolved since it was first defined. Even the most ardent EBM proponents have recognized the need to modify the EBM approach and now include elements such as the patient's clinical state and circumstances, the patient's preferences and actions, and the physician's clinical expertise, as well as the research evidence.29 Part of the clinical expertise required in this model is the ability to interpret and apply the research evidence. This editorial has highlighted some of the challenges faced by clinicians who would treat AD with an EBM approach. It suggests that, without a sophisticated understanding of the primary research studies, it might be hazardous to rely on a single RCT, or even on a systematic review, for treatment recommendations. If expert assistance is required, one solution might be to rely on clinical practice guidelines developed through a consensus approach. Although clinical practice guidelines have also been criticized, 30 they appear to provide the best blend of EBM and expert opinion. The results of the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia will be published shortly. Hopefully, this will provide helpful guidance for Canadian clinicians and their AD patients.